How it Works
Try Naxlex NCLEX-RN (Free-Trial)

A nurse is caring for a school-age child who was involved in a motor vehicle crash.

Exhibits

Complete the following sentence by using the list of options.

The child is at highest risk for developing

evidenced by the client’s .
Answer and Explanation

The Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"D"}

Hypoxia (Low Oxygen Levels): The child's oxygen saturation has decreased from 95% to 93% on room air, which indicates a decline in oxygenation. Although this level is still within an acceptable range, a further drop could indicate respiratory compromise, especially with signs of labored breathing and a nonproductive cough.

Rationale for incorrect options:

Hypotension: The child's blood pressure remains stable (110/64 mm Hg), ruling out a significant risk of hypotension.

Constipation: While the child has hypoactive bowel sounds and hasn't had a bowel movement in two days, this does not pose the most immediate risk.

Dehydration: The child voided 200 mL of clear, yellow urine, suggesting adequate hydration status.


Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Free Nursing Study Resources

Related Questions

Correct Answer is B

Explanation

A. Influenza vaccine – Incorrect. The inactivated influenza vaccine is safe and recommended.

B. MMR vaccine and Varicella vaccine – Correct. Live vaccines should be avoided for 11 months after receiving IV immunoglobulin therapy for Kawasaki disease, as it can interfere with vaccine efficacy.

C. Polio vaccine – Incorrect. The inactivated polio vaccine (IPV) is safe; however, the oral live polio vaccine (OPV) is not recommended in some cases.

D. Hepatitis vaccine – Incorrect. The hepatitis B vaccine is not a live vaccine and can be safely given.

Correct Answer is C

Explanation

A. Trauma to the head or neck area causing a concussion. – Incorrect. Febrile seizures are not caused by trauma.

B. Structural brain lobe defect since birth. – Incorrect. Febrile seizures are not related to congenital brain defects.

C. Sudden rise in body temperature due to inflammation or infection. – Correct. Febrile seizures occur when a child’s temperature rises rapidly, often due to a viral or bacterial infection.

D. Pooling of blood in a cerebral space. – Incorrect. This refers to intracranial hemorrhage, not febrile seizures.

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

Register